Medical Care

Once rhinitis medicamentosa is identified, topical decongestant use must be discouraged and discontinued as soon as possible. Patients need to be educated on their condition and offered other methods of treatment that will help them with the medical conditions that originally triggered the intranasal decongestant use. For allergic rhinitis, for example, this might include allergen reduction/avoidance, pharmacotherapy, and/or allergen immunotherapy. For those patients unable or unwilling to immediately stop intranasal decongestants, several strategies may ease the withdrawal process.

The first week is often the most difficult for weaning or withdrawal. Several studies confirm efficacy of nasal corticosteroids in the treatment and prevention of rhinitis medicamentosa. Although not always necessary, short-course oral corticosteroids, as described below, are the most effective way to break the cyclic use of topical vasoconstrictors. The oral corticosteroids are often used for 5-10 days, with nasal corticosteroids started at the same time and continued until the process is corrected.

Nasal irrigation with saline solutions delivered by devices such as NeilMed may be useful.

Intranasal decongestants can be weaned gradually, allowing patients to use sprays at night in one nostril only and alternating the left and right nostril until congestion is decreased.

Pain relief from analgesics should be offered to patients who experience headaches during withdrawal from intranasal decongestants.

Oral systemic decongestants may be helpful in relieving nasal congestion as intranasal decongestants are withdrawn.

Pregnancy

Rhinitis of pregnancy affects as many as 20% of expecting mothers, although the most common causes of nasal symptoms in pregnant women are the same as in men and nonpregnant women.

Therapy for a pregnant patient with rhinitis medicamentosa generally is the same as outlined above, although oral decongestants should be avoided in the first trimester because of risk of gastroschisis.
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Continuous positive airway pressure (CPAP)-induced rhinitis

CPAP prescribed for sleep apnea, can cause increased air flow through the nasal cavity, which, in turn, causes dry mucous membrane, overproduction of the mucus, and congestion.

Appropriate use of such machines should be ensured, including evaluation of pressure used, regular maintenance, and humidification of the air delivered. Nasal gel is recommended to prevent drying of the mucous membranes of the nasal cavity.

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Surgical Care

Surgical treatment generally is not recommended unless polyps or significantly deviated nasal septum are present and causing nasal congestion. However, when inferior turbinate hypertrophy is present with nasal obstruction and patients have failed medical management, partial inferior turbinate reduction is an option.
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Consultations

Consult an allergist, immunologist, or otorhinolaryngologist if a patient's case is complicated and refractory to treatment or if the primary care physician is unsure of diagnosis.

Disclosure: Received honoraria from MEDA for speaking and teaching; Received honoraria from GSK for speaking and teaching; Received honoraria from MERCK-Sherring for speaking and teaching; Received honoraria from Alcon for speaking and teaching.